Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Internal fixation of acetabular posterior wall fractures].
Open anatomic reduction and stable internal fixation of a posterior wall fracture of the acetabulum by screw and plate osteosynthesis via the Kocher-Langenbeck appoach. ⋯ Between January 1, 1972 and December 31, 2005, 137 patients with fractures of the posterior wall of the acetabulum were treated operatively. A high-velocity trauma was the cause of injury in 91.1% of cases. 94.1% of these patients had an additional hip dislocation, which was reduced within 6 h post injury in 83.7%. A primary sciatic nerve injury was present in 22.2%. Additional injuries to the acetabular cartilage were found in 43%, additional femoral head lesions in 27.4%, and Pipkin fractures in 14.1%. Anatomic joint reconstruction (0-1 mm) was observed in 96.3%, the other five patients had near anatomic reconstructions (2-5 mm). All hip joints were congruent on conventional radiography. The overall complication rate was 11.8%. Osteosynthesis-related complications were seen in 6.7%. 86 patients had follow-up results after a mean of 52 months. A perfect or good functional result (Merle d'Aubigné Score) was observed in 73.3% of cases, a posttraumatic arthrosis of the hip joint was present in 31.4%.
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Internal fixation of acetabular both-column fractures via the ilioinguinal approach].
Open anatomic reduction and stable internal fixation of both-column acetabular fractures by screw and plate osteosynthesis via the ilioinguinal approach. ⋯ Analysis of 27 patients treated between 1991 and 2005. A high-velocity trauma was the cause of injury in 74.1% of cases. Most patients showed an isolated injury of the acetabulum. In 55.5%, an additional central hip joint displacement was observed. A primary injury to the sciatic nerve was present in 14.8% of cases. Mean fracture gap/step was 14.3 mm. 81.5% of these fractures were anatomically reduced and stabilized; all joints were congruent. At 2-year follow-up, 14 out of 17 patients had no signs of posttraumatic osteoarthritis. Excellent and good functional results according to the Merle d'Aubigné Score were observed in eleven and five cases, respectively. One patient had a moderate functional outcome.
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Oper Orthop Traumatol · Sep 2009
Review[Reconstruction of fractures of the anterior wall and the anterior column of the acetabulum using an ilioinguinal approach].
Restoration of the congruence of the hip joint. Correction of gaps or steps in the articular surface, especially in the main weight-bearing area of the acetabular dome. Correction of femoral head subluxation. Restoration of joint stability in order to enable early postoperative mobilization. ⋯ Excellent and good functional results are observed in 73-85% of the isolated anterior column fractures. The anterior wall fracture is a seldom injury. Functional results are worse in comparison to the other simple fracture types. Good or excellent results can only be observed in two thirds of cases. This observation is related to the fact that anterior wall fractures often occur in elderly patients with osteoporotic bone.
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Oper Orthop Traumatol · Sep 2009
Review Clinical Trial[Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)].
Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. ⋯ 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.
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Oper Orthop Traumatol · Jun 2009
Clinical Trial[Endoscopic decompression of the ulnar nerve in cubital tunnel syndrome].
Long endoscopic in situ decompression of the ulnar nerve in cubital tunnel syndrome (sulcus ulnaris syndrome) with direct visualization and minimal incision. ⋯ 52 patients were operated using this method. 53% felt an immediate improvement right after surgery. 47 patients (90%) were available for reexamination after 8 months. Two-point discrimination, grip and pinch strength, and nerve conduction velocity had improved significantly to normal levels. Results, measured with the modified Bishop Rating System, were excellent in 66%, good in 32%, and fair in 2%. There were no poor results. Patients with advanced stages of disease also achieved good results.